Good morning, everyone, and thank you for joining us at this year's 19th annual Canaccord Genuity Musculoskeletal Conference. My name is Caitlin Cronin, and I'm one of the medical device analysts here at Canaccord Genuity. I'm joined today by Xtant Medical, a publicly traded medical device company with a comprehensive portfolio of orthobiologics and spinal motion preservation systems. With me today is Sean Browne, CEO. Before we begin, I want to remind everyone of any relevant disclosures which can be found on our conference and our firm website. With that, I'll turn it over to Sean.
Thank you, Caitlin. Appreciate it. Good morning. As Caitlin said, we've got disclosure statements that are already set up, so I'll dive right in. Xtant Medical, we have been a company that's been around for some time, formerly known as Bacterin Biologics. It was a technology that was founded out of Montana State University, and happily we are based in Bozeman, Montana. We are a business that, over the course of, you know, one of the great things about coming here is that we've been here three years now, and a good part of the first couple of years we spent our time talking about the turnaround. This year I'm so excited because we get to talk about how we're off and through and starting to really grow. So this past year we grew over 50%.
Happily, organically we grew in the mid-single digit, mid-double digits, so we're really, really excited about how we've been growing. We'll be releasing our financial earnings February 29th, so I'll be giving you basically the guidance or the numbers that we've had previously, or that we've released previously. The big message that I want to really emphasize as much as possible about what we're building is really what we're building is this platform for growth. It's a platform that if you look at seeing what we're creating, it's something that, as you think about bolt-on opportunities and ways in which we can expand our footprint, it's all right before us.
So whether it be the exceptional market access we have with IDN agreements and our nationwide distribution network, as well as just what we've been able to do from a scalable size of what we're doing on our biologics as well as our hardware side. So let me get into that a little bit. So the business that we are today, we are in the spine and orthobiologics world. We're a little bit different than most spine companies in the fact that our hardware now, actually after our Surgalign acquisition, only makes up about a third of what we do, while our biologics business makes up about two-thirds.
As we speak, you'll hear me speak about different parts, but one of the things that makes us unique on our hardware side is that we look to focus on those areas that are really more towards procedures that are done outside the hospital. So when you're looking, for instance, we just bought the Coflex interlaminar stabilization device, fantastic product line in way of, you know, preserving motion. So a lot of the things that you're going to hear me speaking about is motion preservation systems, also systems that work outside the hospital. So we've got an outstanding Silex product, which is an SI fusion product, as well as an interspinous process device, which again, very, very is now something used considerably in the ambulatory surgery center world. From a biologics perspective, again, two-thirds of what we sell is in this world.
What we offer is really a full complement of all the different categories that you would need in a spinal procedure. Okay. I'll get into this a little bit more because this is a big part of what we did and when we turned the business around. As I mentioned, you know, I spent the last couple of years when I'd come here talking about what we had to do to fix the business. Today I'm really, really excited because we get to talk about what's coming, what we said we would do, we're now doing.
So if you loodk at in fiscal year 2023, not only do we have outstanding organic growth, but we were able to add on Coflex, as I mentioned earlier, we added on the rest of the Surgalign business, which was a business that was in a fair amount of turmoil given the challenges that were going on within that business. And then on top of that, there was also a Nanoss product line that we were able to acquire where they didn't have necessarily the production rights. We bought the production rights and we bought the production within the Nanoss facility. So we've had a really terrific year when you look at the growth and what this business means for us.
What I'm most happy about these businesses, which were businesses that were, they were struggling, is that we've got them, we've got them really stabilized and now we're poised for growth with not only their business but also with the base Xtant business. So when you look at our team, great team. I've got a wonderful group of guys that have been part of this turnaround and have had either really deep, deep, deep experiences in the bioproduction side like our friend Mark does or like Scott and I have had on the turnaround side. And while Kevin has been somebody who's been in the spine world for over 30 years, so we've had a really, really terrific team and a great group of people in Bozeman that help support all that we're trying to do.
So when you look at our business, you start to see it really start to take off. And in this, as I mentioned, you know, 50%+ overall growth. But more importantly, when you look at the mid-double digits growth that we've had organically, we were acquiring these businesses while keeping our eye on the ball, still growing our core business. When we look at our platform, and this again, this is the part that I think is, is if you were to walk away and say, what is it that I'm going to, what do I remember about Xtant? It's the platform that these guys that we are building that gives you, one, outstanding market access to IDNs and GPOs. It gives you a national distribution network of over 650 independent agents that are out there selling our products today.
You've got an expanded biologics production capabilities where before we really only produced two different product lines, today we'll be doing five and six. And so we'll get into what that means for us from a profitability perspective. But then when you look at the managed care, you know, it's one thing when you understand what takes place in the IDN and those hospital contracts, but it's an entirely different scenario when you start getting into what it means to understand the payer side of things. And through the Coflex acquisition, we now have a payer services group as well, which is again adding to what we will be able to do from a capabilities perspective.
From an international side, another part that we did is that we bought within the Surgalign acquisition a really neat international business that, just to put it shortly, they had a number of great assets that were part of the Paradigm acquisition from way back when RTI bought that acquisition. So in that group, there were some three to four different motion preservation systems. A couple of those systems are systems that we need to bring here in the United States because they're absolutely outstanding. And then last but not least is this idea of the motion preservation. You know, when we think about the idea of actually fusing a joint, because that's essentially what you're doing when you're fusing a disc space, that's a joint. Can you imagine fusing a knee or an elbow, a shoulder?
It's just not something you do, but yet we do it every day in the spine world. What we have are systems that we're going to be bringing forward like the Coflex system today. They're actually going to help maintain motion. So the market we serve is huge. A year ago, I would talk about only really the domestic side of things. Now today we're actually, we do have an international footprint, and this international footprint is really poised very well for growth, especially because when you think about what's taken place from an MDR, when you think about what MDR has done, it's had a lot of different companies leave specifically Europe where we're now in Europe and we now have opportunities that are coming to us that we didn't expect before. So that's something that's new to what we're offering today.
But when you look at the overall orthobiologics market, and I'll dive a little deeper in this, is that there are really five major segments within the orthobiologics space. Originally, when I first got here at the company, we were only doing the demineralization and allograft world. Well, very quickly in 2021, as we started raising money, we were able to add the cellular allograft, the synthetic side, as well as the growth factor world. And so these are really wonderful areas that are fast-growing markets for us and a big part of the organic growth that we've seen. When we think about what we are producing, again, was really still the old lower profit DBM and allograft spaces. And in the next year or so, we are going to have really all of these. Today we already produce synthetics, which again, very high margin products.
We will soon be getting amnio growth factor as well as our viable bone matrix up and running as well, completely changing in many respects our entire profitability profile. So when we think about our growth platforms, this is a slide that I've been staying with and literally since the day I started, this is what we're doing. This is how we're going to grow new products, expanding our footprint in tier one is new products. Tier two is expanding our product, expanding our footprint. Tier three is essentially leveraging those adjacent markets that we touched today through our production. And the level of pillar four for us is our M&A side of things. So let me touch on each one.
So when we think about a healthy, really robust company, every robust and healthy company has a very strong new product segments that are coming out, new products that they're rolling out. In our case, both in the orthobiologics as in the spinal hardware, we have a lot that's taken place this year just alone with what we are going to be doing in way of revamping even some of our old core products as well as some of the new products that will be rolling out. Additionally, when we look at our hardware side, our hardware side has got a whole slew of new opportunities that for us that we haven't had, never mind the prospect in the years to come of being able to bring some of those products that are in Europe today here to America on the Motion Preservation side.
When we think about pillar two, expanding really our distribution network, it one first starts with access. How are you doing or what are we doing to actually get those contracts so that our distributors and our surgeons can use our products? This is step one. Today we do actually a very, very good job, especially for a smaller size company. You know, when you think about a subscale company and something that we hope to be very quickly is scaled. But here we are today with over 450 IDN agreements, all the major GPO agreements. We estimate that we have over 90% of the beds covered just with what we have in IDN agreements here in America. When you look at building that national network through what we were able to do a year ago, we had 300 independent agents that were selling something of ours.
Today we've got over 650 with the acquisition of both the Surgalign as well as the Coflex. They added, they doubled what we have in way of access. So today, where a year ago we were looking to fill certain regional areas, we got the country covered. Now it's a matter of getting greater penetration. So those are the things that we'll be working on next. Then when you look at the adjacent market opportunities, so what this gives for us today is that when you think of these different verticals that we already serve, so product areas, you know, other non-spine, and especially when you think about anything to have to do with the oral maxillofacial, things in the total joint side, those are areas we serve as we speak. But in addition, we also start to serve the wound care side again in an OEM capacity.
So we're not somebody who's fighting it out in the reimbursement world in that, but really serving in the OEM side. And then last but not least, we have been serving the sports medicine market for some time with what we do with our tendons. And we think that there's some other opportunities that we have in that world again as an OEM opportunity. Last but certainly not least is our pillar four. This is where we're really the integrator of really enabling technologies. We're the guy that's out there that has, I think, a vehicle, an exit for small, undersized, undercapitalized, cash-constrained companies that can come to us and we can add them to our platform.
And so today, as I look at things, you know, when we think about over the four years that we've been here together, the team that I've been part of, we've had a chance to really look at a number of different technologies. And we would be begging them, hey, come join us, come join us. We're going somewhere. And happily today, those calls are being returned, which is a good thing. But then B, the fact that we are now really establishing ourselves as we've increased our market cap and we now have a greater currency to work with. So the types of companies that we're looking for, and especially as we start thinking about where this business is going for the long run, is that first and foremost, we got to expand our capabilities. Second, we always have to look for ways to increase our capacity.
And then third, looking at ways to continue our profitability. From a profitability perspective, I'm really excited because today, you know, we are adjusted EBITDA positive, and it is something that will continue over the course of the, you know, this is from this time in eternity. This is going to be a big part of what we acquire is going to be something that's going to be giving us even more in way of financial strength. So as we think about our business moving forward over the course of the next year, this last year, 2023, I said to my team, this is transforming Xtant. This is the year where we're really going to start changing who we are. When I think about 2024, this is about self-sustainability.
This is where we get not only where we're sourcing most of our own products where we can, but then two, we're also going to be a lot more profitable. So we don't need to necessarily have to reach out and get money from others, which we love. All of you guys, don't get me wrong. But when we come to you, we're going to come to you because we have acquisitions or other big things that we're looking to do. So this is the year of self-sustainability. So when we think about the summary of who we are and what we're about, so this really lays it out. Strategically, we're leaning forward platform for growth. Remember, that's the big thing I was trying to really emphasize more than the analysis. We have this platform. It's a fantastic place for us to take technologies and grow with them from here.
When you think about our chairman that we brought on, and I should have mentioned him earlier, we brought on Stavros Vizirgianakis in August of 2022. He's both an investor, so he sits side by side with many of you in the room here, but he's also a guy who's been there, done that, and he's been an extraordinary influence in our business. So operationally, proven management team, expanding our capabilities as we speak, but also when you think about it, improving our margin profile. So over the course of the next year, that's one of the things you'll start to see as we talk about our self-sustainability. And then financially, 50%+ growth profile, cash flow positive, very clean balance sheet.
So overall, we think that we are off to a really nice beginning, and we, you know, think that there's some big things that are ahead for us. So with that, I'm done. What questions might you have?
I can start with one. Sure. How do you plan to really improve the amount of clinical data in your product portfolio?
Yeah. Oh, that's a great question. Thank you. One of the great things about adding Mark Shallenberger to our team is that this is a world, and it's the gentleman before me, I'm sorry, had spoken about the dearth of clinical data that's out there today. And so that's one of the things that as we look at not only from a clinical perspective, but then a regulatory side. So we are one of the few biologics manufacturers that also are ISO 13485.
So we have 510(k), our biologics, like for instance, our putty is a 510(k) product, right? We want to be able to not only take products that will show that are proved clinically better. So there are investments that we're making today to do that, but then also start to upregulate where possible. Yes, sir.
I'm Sean. Congratulations on growing your business. Just wanted to reach out.
Great. Thank you.
I'm a shareholder for over 20 years, two weeks since the cut. But you have a large shareholder group's private equity.
Yes.
How does that measure up with Xtant as a public company? Because often private equity groups have their own agenda.
Sure. Yes, absolutely. OrbiMed. So you're speaking of OrbiMed, 56% shareholder for us today. They have actually great news. This is probably one of the things we should put on a slide here.
Is there a reason for stepping off the board back in May? And that reason was they had so much confidence in what we were going and what we were doing that it's going to give them the ability to start looking and trying to find a way to start to exit. And so, but they want to do this in a way that doesn't, A, kill the stock, right? And do this in a very, very measured way where also they see the upside. But, but, but, but, but I'll also throw this out is that this is they recognize that they need to get shares into the market because this is a stock that needs greater float. And so this is something we are working with them to do in a very, very measured way.
And so, as you think about it over the course of time, like as we, you know, hopefully every time we acquire somebody, we also get multiple expansion that goes with that. And so as we get multiple expansion, as the pie gets bigger, we're hoping that their size also goes down significantly whereas they start to trade out, it's going to be something that the market doesn't even notice. But yes, that is, let me, that's one of the big things that we talk about on a regular basis, just between the groups of how do we do this so it is as shareholder-friendly as possible?
Can you talk about the competition in the motion preservation space and how you plan to really compete there?
Yeah. Yeah. Good, good, good question.
Motion preservation is one that has kind of a checkered past over the course of many years. One of the best examples of what came out as a really terrific product was Coflex. The surge in adoption of that was outstanding. What got in the way with that was actually reimbursement, right? And so reimbursement is the challenge we took on. And quite frankly, my entire team who hadn't been in a world, so previously I'd been in the diabetes world. So reimbursement is everything you do. You don't even worry about contracts with IDNs. You worry about contracts with, you know, United and Aetna and everyone else.
But this was an opportunity when you look at the amount of data, 225,000 patients with an implant today, just here in North America, just here, I should say, in the United States, over 90 clinical trials, great clinical, I mean, just the prevalence or just the amount of data that we have. We thought that there was a way where we could, and by the way, it is already Medicare cleared or Medicare approved Part B cleared product. So there is a huge market for us already. And so that's the first step. But there were other technologies that were out there. I just think that the world now is a lot more informed, and I think there's a lot more surgeons, quite frankly, that look at this and say, you know, do we really want to be fusing things, right?
I mean, you know, adjacent levels, we have some unbelievable data that our team in Europe has done around adjacent level syndrome. Looking at all of those motion preservation systems, so we got this one that we're going to be producing here soon. It's a meta-analysis. It's looked at thousands of procedures or thousands of clinical trials. In those clinical trials, you'll just see that these motion preservation systems writ large were very successful from not getting adjacent level syndrome. So. Any other questions? Well, great. Thank you for the time and go Xtant.